Highmark will cut physician payments to stem ACA-compliant plan losses

As part of a broader effort to stem losses from Affordable Care Act plans, insurer Highmark Inc. will cut physician reimbursement rates for those plans by 4.5 percent starting in April.

The insurer lost about $500 million on marketplace plans in 2015, Alexis Miller, Highmark's special vice president of individual and small group markets, told the Pittsburgh Tribune-Review. Cutting payments to doctors will allow Highmark to stay in the federal marketplace, ultimately helping to keep it sustainable, she added.

That's a theme that's been echoed by other health insurance execs. As UnitedHealth Group CEO Stephen J. Hemsley put it, "we can't really subsidize a marketplace that doesn't appear at the moment to be sustaining itself."

But doctors shouldn't have to subsidize the losses, either, John Krah, executive director of the Allegheny County Medical Society, told the Tribune-Review. "It's inappropriate for Highmark to seek to compensate for their failure to price these products appropriately by paying physicians less," he said.

Insurers are struggling to make money on exchange plans, with some companies lobbying for more flexibility and others threatening to stop selling the plans altogether. UnitedHealthcare says it lost $720 million on its Affordable Care Act-compliant plans in 2015 and has threatened to stop selling exchange plans. Cigna CEO David Cordani, meanwhile, says that although his company also is struggling, he intends to take a long-term view of the market.

To learn more: 
- here's the Pittsburgh Tribune-Review article

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